Challenge Area: 5. Comparative Effectiveness Research Challenge Topic: Behavioral and Medication Interventions To Treat Drug Abuse Disorders in Non-Specialty Care Settings (05-DA-101) Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the current quality of care for SUD is mediocre and that profound changes must occur in systems of care in order to translate groundbreaking science into meaningful improvement for the millions of Americans suffering with SUD. Progress on solving systemic problems in SUD care has been impeded by a lack of good science regarding system change in healthcare, the complex multi-level (e.g., regulatory, clinical delivery, financing) obstacles to SUD system change, and limitations in comparative effectiveness research to provide informative knowledge to guide policy. This proposal will capitalize on a unique set of policy events occurring in New York State (NYS) led by Governor Paterson that seeks to transform the entire SUD care system, with a special focus on criminal offenders with SUD. We believe the momentum created by these events can be harnessed to jumpstart a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions. Specifically, we plan to work with Ed Wagner and colleagues to extend their state-level CCM interventions to SUD using NYS as a laboratory. We have strong support from the Governor's Office and the relevant state agency Commissioners to partner in this venture. The proposal has two specific aims: 1) to develop a state-level model to treat addiction as a chronic illness across multiple agencies (e.g., substance abuse and criminal justice) and system components (e.g., financing, regulation, service delivery) and 2) to conduct all developmental work necessary to design a rigorous comparative effectiveness research (CER) trial to test a chronic care model for SUD offenders. During the grant period, we will convene a multi-specialty group comprised of scientists and government leaders. As described in the application, this group will oversee activities and complete a clearly defined set of products related to study aims within a two year time period. Substance Use Disorders (SUD) are among the most prevalent and costly health conditions in the U.S. Experts agree that the quality of care for SUD is mediocre. This proposal will capitalize on a unique set of policy events occurring in New York State to jump start a science-based, systems-level transform of the SUD care system and in the process create a national model for state-level interventions to improve the quality of care and reduce costs associated with SUD.